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MANICKAVASAGAM, EZHILARASI
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
5606 SW LEE BLVD
SUITE 201
LAWTON OK 73505
Address last updated on 5/5/2020 |
| Phone #: |
(580) 699-3000 |
| Fax #: |
(580) 699-2975 |
| County: |
COMANCHE |
| License: |
32236 |
| Dated: |
5/17/2016 |
| Expires: |
5/1/2021 |
| License Type: |
Medical Doctor |
| Specialty: |
Pediatrics |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Vinayaka Mission M C, Karaikal, Pondicherry Univ, Pondicherry, UT, India |
| Graduated: |
5 /
2003 |
| CME Year: |
2022 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF PEDIATRICS |
| New Patients: |
Yes |
| Medicaid: |
Yes |
| Medicare: |
No |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
None listed |
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